Effective October 15, 2025: Transition of Utilization Review for Automatic External Defibrillator
Date: 08/15/25
Effective October 15, 2025, prior authorization requests for procedure code K0606 Automatic External Defibrillator will transition from Evolent Specialty Services, Inc., Texas (URA #1777359) to Centene Management Company, LLC, Texas (URA #5396) for Superior Medicaid (STAR, STAR Health, STAR+PLUS), STAR+PLUS Medicare-Medicaid Plan (MMP) and Wellcare By Allwell (Medicare) members aged 21 and older, and Ambetter from Superior HealthPlan members aged 18 and older.
Beginning October 15, 2025, all prior authorization requests for K0606 Automatic External Defibrillator must be submitted to Centene Management Company, LLC, Texas (URA #5396) for Superior through one of the following prior authorization request submission methods:
- Online:
- Phone:
- Medicaid, CHIP and Ambetter: 1-800-218-7508
- Medicare and MMP: 1-855-538-0454
- Fax:
- Medicaid, CHIP and Ambetter: 1-800-690-7030
- Medicare and MMP: 1-833-562-7172
Procedure Code | Applicable Products | Criteria |
K0606 - Automatic external defibrillator, with integrated electrocardiogram analysis, garment type | Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP) and Wellcare By Allwell, and Ambetter from Superior HealthPlan | Medicaid, CHIP and Ambetter: Change Healthcare’s InterQual criteria, proprietary, but available upon request for procedure code K0606
Medicare and MMP: Local Coverage Determination (LCD): Automatic External Defibrillators (L33690) in compliance with Centers for Medicare & Medicaid Services (CMS) rules
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Superior ensures medical necessity review criteria is current and appropriate for members and the scope of services provided.
To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.
For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.